751-6 Multiple Repeat Coronary Angioplasty for Final Lesion Patency

To demonstrate that multiple repeat coronary angioplasty can be solely utilized to achieve final lesion patency after restenosis, such a protocol was prospectively applied for restenosis since 1983. Bypass surgery was only considered for 1) new left main trunk lesions, 2) symptomatic restenosis where angioplasty was either unsuccessful or unsuitable, and 3) patient preference. Between 1983 and 1992, 1455 lesions (acute myocardial infarction or total occlusion excluded) were successfully dilated for the first time. Although only 941 (68%) of the 1385 lesions studied showed satisfactory patency (≤ 70% stenosis) after the first procedure, 93% (1248/1345 studied) showed satisfactory patency after repeating angioplasty up to 3 times and 94% (1268/1354 studied) after repetition up to 6 times. Only 23 lesions 11.6%) required 4 or more procedures and 20 of them showed final patency. Disease aggravation (either impossible or failed repeat angioplasty, acute infarction, or sudden death) occurred in 43 lesions (3.2%). Bypass grafts were done for 11 lesions of 7 patients, mostly due to disease progression at the left main trunk. Dilatation (stenosis) Patent (0–50%) Mild (55-70%) Re-do(75%-) Grafts(75%-) Medical(75%-) Aggravated # Withdrawal Cumulative 0–70% No * 1st 874 67 384 9 16 32 73 941 1382 2nd 221 22 97 0 6 7 31 1184 1351 3rd 53 11 23 0 1 3 6 1248 1345 4th 11 1 8 1 0 1 0 1261 1345 5th 3 3 2 0 0 0 0 1267 1345 6th 1 0 0 1 0 0 0 1268 1345 * :1763- ∑ Withdrawal # :sudden death. acute infarction or irreversible occlusion Conclusion These findings indicate that 1) repeat angioplasty can be the main treatment strategy for restenosis, 2) multiple repeat angioplasties (up to 6 times) can be effective and rarely aggravate coronary anatomy and 3) disease aggravation must be prevented to improve the final patency rate of repeat ang ioplasty.